| NPI | 1295386530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0732005677) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0732006869) |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2019-09-27 |